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Objective Large inter-individual variability in the pharmacokinetics of rilpivirine and cabotegravir has been reported in the first weeks after starting long-acting injectable (LAI) therapy. Here, we assessed the distribution of rilpivirine and cabotegravir trough concentrations in people with HIV (PWH) on long-term LAI treatment. Methods Adult PWH treated with LAI for at least 32 weeks with an assessment of drug plasma trough concentrations were considered. The proportion of rilpivirine and cabotegravir plasma trough concentrations below four-times the protein-adjusted concentrations required for 90% inhibition of viral replication (4×PA-IC90) was estimated. Results Sixty-seven PWH were identified. LAI treatment duration was 216 ± 80 weeks (range 32–320 weeks). Cabotegravir concentrations were associated with lower inter-individual variability compared with rilpivirine (45% versus 84%; P  < 0.05). No differences were found in rilpivirine (160 ± 118 versus 189 ± 81 ng/mL; P  = 0.430) and cabotegravir (1758 ± 807 versus 1969 ± 802 ng/mL; P  = 0.416) trough concentrations in males (n  = 55) versus females (n  = 12). A non-significant trend for lower cabotegravir concentrations was found in PWH with a body mass index >30 kg/m2 (n  = 9) versus non-obese participants (1916 ± 905 versus 1606 ± 576 ng/mL; P  = 0.131). Three out of the 67 PWH had at least one drug concentration <4×PA-IC90: 100% of PWH had undetectable HIV viral load. Conclusions At steady state, optimal systemic exposure of cabotegravir and rilpivirine was found in most PWH; cabotegravir trough concentrations were associated with lower inter-individual variability compared with rilpivirine. The study was not powered to assess the contribution of sex and/or body weight on LAI exposure due to the small number of females and obese PWH included. [ABSTRACT FROM AUTHOR]

This article discusses the use of fostemsavir, a first-in-class attachment inhibitor, to overcome potential drug-drug interactions (pDDIs) between chemotherapy and boosted protease inhibitors (bPIs) in heavily treatment-experienced people with HIV (PWH) and cancer. The authors present two cases of PWH with solid malignancies who were able to undergo first-line chemotherapy with the use of fostemsavir to avoid pDDIs. The authors suggest that fostemsavir provides an additional option for constructing a suppressive antiretroviral regimen in PWH with cancer, but caution that strict virological monitoring is necessary. They also mention the potential for fostemsavir to increase the exposure of paclitaxel, a chemotherapy drug, and advise clinicians to monitor for potential paclitaxel-related toxicity in PWH treated with fostemsavir. [Extracted from the article]

A study conducted in Milan, Italy, examined the effectiveness of a two-drug regimen of doravirine plus lamivudine in people living with HIV. The study found that out of 22 patients who received this regimen, 7 discontinued it, with 3 discontinuations due to virological failure. The study concluded that this regimen should only be used as a last resort when no other options are available and both drugs are expected to be fully effective. The authors of the report have disclosed their potential conflicts of interest, which is important for readers to consider when interpreting the findings. [Extracted from the article]